title: Use of evidence in clinical guidelines and everyday practice for mechanical ventilation in Swedish intensive care units.
abstract: OBJECTIVE
  One way to support evidence-based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice.
  
  
  METHODS
  Inviting all general ICUs in Sweden (N = 65), a national survey was performed on occurrence of MV guidelines, and a review of submitted ICU guidelines by four evidence items from the AGREE instrument. In addition, ICU head nurses and senior physicians were interviewed using semistructured and open-ended questions to explore development and dissemination of MV guidelines, staff adherence or nonadherence to guidelines, and everyday practice of MV management bedside.
  
  
  RESULTS
  Fifty-five ICUs (85%) participated in the study; 51 ICUs submitted a total of 245 guidelines, including recommendations for medical or nursing MV actions. None of the documents included how evidence had been sought or assessed, while 22% included a list of references (n = 54). No guidelines included patients' experiences of MV. According to the managers, the guidelines were most often compiled by a multiprofessional team sharing the information through the ICU's website. The guidelines were mainly used as a basis for MV management bedside, but variation occurred as a result of personal preferences, lack of awareness, and adjustment to patients' needs.
  
  
  CONCLUSIONS
  Local MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.
authors.affiliation: Research Fellow, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.forename: Gisela
authors.initials: G
authors.lastname: Vogel
authors.forename: Anna
authors.initials: A
authors.lastname: Söderberg
authors.forename: Hans
authors.initials: H
authors.lastname: Blomqvist
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Wengström
mesh_terms: D064648:Critical Care Nursing / Q000592:standards*; D055317:Evidence-Based Practice / Q000592:standards*; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards*; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: evidence-based practice; guidelines; intensive care; knowledge translation; mechanical ventilation; patient experiences